- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.92 / $374.76 / $449.32
| Professional | | $301.92 | $374.76 | $449.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.00 / $1,040.00 / $1,610.00
| Professional | | $780.00 | $1,040.00 | $1,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.32 / $621.97 / $1,069.45
| Professional | | $349.32 | $621.97 | $1,069.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.16 / $730.80 / $1,667.14
| Professional | | $404.16 | $730.80 | $1,667.14 |